From this article you will learn about such an ancient method of studying the state of health, as auscultation of the heart. The history of the method, the basic principles of auscultation and disease, which can be identified or even suggested using this technique.
- The basic rules of auscultation of the heart
- Two heart tones
- Technique and points of auscultation of the body
- What diseases and conditions can be detected by auscultation
Auscultation, or listening is a method of evaluating certain functions of the human body, based on the analysis of sounds that are publishedcertain body systems in their work. Listening to the heart is not the only point of application of the method. Listening, or auscultirovat, you can vessels, lungs, intestines. Of great importance is the technique in obstetrics, because through the anterior abdominal wall of the mother can hear the noise of the vessels of the placenta and the heart tones of the fetus. The auscultatory method is the basis for measuring blood pressure by the Korotkov method - the one that we all use when we measure pressure with a tonometer.
The earliest healers used the method of listening, but for this they applied the ear to the chest, back, or stomach of the patient. By right of the father of modern auscultation it is possible to name the French doctor Rene Lajeneka who, observing rules of decency, could not put an ear to a breast of the young girl. That's why he rolled a sheet of paper into the tube, applied it to the heart area and found that the audibility of heart sounds thus increased several times. It was Lienenek who invented the prototype of a modern stethoscope - a tube with which doctors perform auscultation. He also gave initial principles to such a concept as the points of auscultation of the heart - certain places on the chest, in which the distinct noises and sounds of each of the structures of the organ are most clearly heard. About these points and their meaning, we'll talk just below.
Basic heart auscultation rules
This simple method, like listening, requires strict rules:
- The doctor should only use his checked stethoscope. That is why cardiologists and therapists sometimes use a single stethoscope all their life and will not be lent to anyone.
- The stethoscope should correspond to the age of the patient - that is why in pediatrics and neonatology there are special children's stethoscopes or special attachments to the usual.
- The nozzle to the stethoscope should be warm, like the air in the room.
- The study should be conducted in silence.
- The patient should take off his clothes to the waist.
- The patient is mostly standing or sitting, the doctor is in a comfortable position.
- The tip of the stethoscope should fit snugly against the skin.
- If the scalp on the patient's skin is very pronounced, then the skin in this place should be wetted or oiled with liquid oil.
Two heart tones
The heart is a complex organ consisting of muscle fibers, connective tissue framework and valve apparatus. Valves separate the atrium from the ventricles, as well as the chambers of the heart from large or major vessels that emanate or come into the heart chambers. All this complex structure is constantly in motion, rhythmically contracting and relaxing. Valves open and close, blood jerks moving inside the vessels and chambers of the body. Each element of the heart creates certain sounds, united by doctors into the concept of heart tones. There are two main cardiac tones: the first( systolic) and the second( diastolic).
The first tone of the
The first tone of the heart arises at the moment of its contraction - systole - and is formed by the following mechanisms:
- Valve mechanism - slamming and corresponding vibration of the flaps of the bivalve( mitral) and tricuspid valves that separate the atrium from the ventricles.
- The muscular mechanism is the contraction of the atria and ventricles and the expulsion of blood further along the course of its movement.
- Vascular mechanism - vibration and vibration of the walls of the aorta and pulmonary artery when passing a powerful blood stream from the left and right ventricles, respectively.
The second tone
This tone occurs when the heart muscle relaxes and its rest is diastole. It is not as multicomponent as the first, and consists of only one mechanism: the valve mechanism - slamming the valves of the aorta and pulmonary artery and their vibration under the pressure of blood.
Phonocardiogram - recording of vibrations and sounds produced by the activity of the heart and blood vessels Technique and points of auscultation of the body
During the hearing, the physician should distinguish and evaluate the following parameters of the heart:
- Heart rate( heart rate) - normally it varies on average from60 to 85 beats per minute.
- Rhythmic heartbeat - the heart normally works rhythmically, contracting and relaxing through certain lengths of time.
- Sound or volume of heart tones - the first and second tones should be of a certain volume. The first tone should be louder than the second, not more than twice. Of course, not only the disease, but also the thickness of the chest cage, the weight of the patient, the thickness and massiveness of the subcutaneous fat can influence their sound.
- Integrity of heart tones - the first and second tones should be heard completely, without dividing or splitting.
- Presence or absence of pathological heart tones, noises, clicks, crepitus and other signs of heart disease and other organs.
To auscultation of the heart was correct, it is important to follow a certain sequence of listening to heart tones. Still the inventor of the stethoscope Lainenek has developed a certain algorithm for listening to the heart and has identified places - points of listening - where some of the nuances of his work are heard more clearly. Modern diagnostics calls these places the points of auscultation of the heart, which we mentioned at the beginning of this article. It is at these points that not only the first and second tone is heard, but each of them is the place of the best listening of a certain heart valve, which is extremely important for preliminary diagnosis.
There are five such points, they practically form a circle, along which the stethoscope of the researcher is advancing.
- 1 dot is the place near the apex of the heart, in which the mitral or bivalve valve separating the left chambers of the heart is most distinctly heard. Usually this point is spotted at the place of attachment to the sternum of the cartilage of the IV rib on the left.
- 2 point - this is the second intercostal space to the right of the edge of the sternum. In this place, the sounds of the aortic valve closing the mouth of the largest artery of the human body are best heard.
- 3 point - this is the second intercostal space to the left of the edge of the sternum. At this point, the sounds of the pulmonary valve work, carrying blood from the right ventricle into the lungs for enriching with oxygen, are heard.
- 4 point - this is the place at the base of the xiphoid process of the sternum - "under the spoon".This is the point of the best audibility of the tricuspid, or tricuspid, heart valve dividing its right halves.
- 5 point, called in medical textbooks Botkin-Erba point - III intercostal space near the left edge of the sternum. This is the place of additional listening to the aortic valve.
It is at these points that the abnormal sounds are best heard, which speak of certain violations of the valvular heart apparatus and abnormal blood currents. Experienced doctors also use other points - above the large vessels, in the jugular section of the sternum, underarm area.
What diseases and conditions can be detected with the help of auscultation
It should be noted that a few decades ago, auscultation of the heart was one of the few methods for diagnosing diseases of the cardiovascular system. Doctors trusted only their ears and exhibited complex diagnoses, unable to confirm them by any instrumental methods, except electrocardiograms or chest X-ray.
Modern medicine is equipped with a huge arsenal of methods and technologies, so the auscultation undeservedly receded into the background. In fact, this is a cheap, affordable and quick method that allows in a broad stream of patients to tentatively identify people who need a more thorough examination: ultrasound of the heart, angiography, Holter monitoring and other modern but far from inexpensive methods.
So, let's list the main characteristics of pathological heart sounds, which helps to identify auscultation of the heart.
Changing the sonority of heart tones
- Attenuation of 1 tone is observed in myocarditis - inflammation of the heart muscle, myocardial dystrophy, insufficiency of the mitral and tricuspid valve.
- Strengthening of the first tone occurs with a narrowing of the mitral valve - stenosis, pronounced tachycardia and changes in the heart rhythm.
- Attenuation of the second tone is observed in patients with a drop in blood pressure in the large or in small circulation circles, aortic valve insufficiency and aortic malformations.
- Strengthening of the second tone occurs when the arterial pressure rises, the walls are compressed or atherosclerosis of the aorta, the stenosis of the pulmonary artery valve.
- Attenuation of both tones is observed with patient obesity, dystrophy and poor cardiac function, myocarditis, fluid accumulation in the cavity of the cardiac bag after inflammation or trauma, severe emphysema.
- Strengthening of both tones is observed with increased contractility of the heart, tachycardia, anemia, exhaustion of the patient.
The appearance of heart murmurs
Noise is an abnormal sound effect superimposed on heart tones. Noise is always caused by abnormal blood currents in the cavities of the heart or by passing it through the valves. The noise is estimated at each of the five points, which allows you to determine which of the valves is not working properly.
It is important to evaluate loudness, sonority of noise, their prevalence in systole and diastole, duration and other characteristics.
- Systolic murmur, i.e., noise during the first tone, may indicate myocarditis, papillary muscle damage, insufficiency of the two- and tri-flap valves, mitral valve prolapse, aortic and pulmonary valve stenoses, interventricular and atrial septal defect, atherosclerotic heart changes.
Systolic murmurs can sometimes be present in MARS or small heart disease anomalies - when there are certain anatomical features in the structure of the organ and the main vessels. These features in no way affect the work of the heart and blood circulation, but can be detected with auscultation or ultrasound of the heart. - Diastolic murmur is more dangerous and almost always indicates a heart condition. Such noises occur in patients with stenoses of mitral and tricuspid valves, inadequate aortic and pulmonary valve function, tumors - atrial myxomes.
Pathological heart rhythms
- The rhythm of the canter is one of the most dangerous abnormal rhythms. This phenomenon occurs when splitting the heart tones and sounds similar to the hoof of hooves "ta-ra-ra".Such a rhythm appears with severe decompensation of the heart, acute myocarditis, myocardial infarction.
- The rhythm of a pendulum is a two-beat rhythm with the same pauses between the 1 and 2 heart tones that occurs in patients with hypertension, cardiosclerosis and myocarditis.
- The quail's rhythm sounds like "sleeping on-ra" and is combined with mitral stenosis, when the blood flows with a huge force through the narrow ring of the valve.
Auscultation can not be the main criterion for setting a diagnosis. Be sure to take into account a person's age, complaints of the patient, especially his body weight, metabolism, the presence of other diseases. And in addition to listening to the heart, all modern cardiac examinations should be used.